Prosthetic mesh products have radically changed the repair of all types of hernias. The benefits of mesh repairs have been clearly established in clinical practice, with recurrence rates significantly lower compared to repairs performed without mesh reinforcement. The search for an ideal mesh, however, is ongoing. The characteristics of an ideal prosthetic would include being chemically inert, resistant to mechanical stress, resistant to infections, pliable, and less likely to provoke inflammation and foreign material reactions. Although a wide variety of prosthetic meshes have been used in surgical procedures, no single prosthetic mesh has yet been able to achieve all of the above-identified characteristics.
The long-term implantation of prosthetic mesh is often associated with decreased abdominal wall compliance. Many prosthetics, although chemically inert, generate an intense inflammatory reaction. The result is a pronounced perifilamentous fibrosis and deposition of collagen fibers producing a rigid scar plate and prosthetic mesh “stiffness.” In the long-term, such acquired stiffness of mesh products contributes to abdominal wall rigidity, leading to the changes in compliance of both the hernia site and the whole abdominal wall. Clinically, this decrease in compliance can lead to a sensation of firmness of the abdominal wall and result in physical discomfort and significant limitations in the activities of daily living in many patients. Additionally, areas of the abdominal wall that lack prosthetic mesh coverage may experience an increase in herniation as the abdominal pressures are no longer distributed evenly.
Although the clinical benefits of prosthetic mesh repairs have been well established, the effects of prosthetic meshes on patients' quality of life and physical comfort are not well known. Quality of life in hernia patients have traditionally been measured with generic quality of life surveys such as the Rand 36-Item Health Survey (SF-36® questionnaire, Medical Outcomes Trust, Inc, Boston, Mass.). Although this survey has been validated by numerous studies, it doesn't relate specifically to problems/concerns patients have after undergoing hernia repairs with prosthetic mesh. As a result, the ability to identify prosthetic meshes and techniques that most closely meet the desirable characteristics of an ideal hernia repair has been limited.
Thus, there still exists a need for a method of identifying a hernia repair procedure that will have a smaller impact on a particular patient's quality of life.